title: Efficacy of PEEK cages and plate augmentation in three-level anterior cervical fusion of elderly patients.
abstract: BACKGROUND
  To evaluate the clinical efficacy of three-level anterior cervical arthrodesis with polyethyletherketone (PEEK) cages and plate fixation for aged and osteoporotic patients with degenerative cervical spinal disorders.
  
  
  METHODS
  Twenty one patients, who had undergone three-level anterior cervical arthrodesis with a cage and plate construct for degenerative cervical spinal disorder from November 2001 to April 2007 and were followed up for at least two years, were enrolled in this study. The mean age was 71.7 years and the mean T-score using the bone mineral density was -2.8 SD. The fusion rate, change in cervical lordosis, adjacent segment degeneration were analyzed by plain radiographs and computed tomography, and the complications were assessed by the medical records. The clinical outcomes were analyzed using the SF-36 physical composite score (PCS) and neck disability index (NDI).
  
  
  RESULTS
  Radiological fusion was observed at a mean of 12.3 weeks (range, 10 to 15 weeks) after surgery. The average angle of cervical lordosis was 5° preoperatively, 17.6° postoperatively and 16.5° at the last follow-up. Degenerative changes in the adjacent segments occurred in 3 patients (14.3%), but revision surgery was unnecessary. In terms of instrument-related complications, there was cage subsidence in 5 patients (23.8%) with an average of 2.8 mm, and loosening of the plate and screw occurred in 3 patients (14.3%) but there were no clinical problems. The SF-36 PCS before surgery, second postoperative week and at the last follow-up was 29.5, 43.1, and 66.2, respectively. The respective NDI was 55.3, 24.6, and 15.9.
  
  
  CONCLUSIONS
  For aged and osteoporotic patients with degenerative cervical spinal disorders, three-level anterior cervical arthrodesis with PEEK cages and plate fixation reduced the pseudarthrosis and adjacent segment degeneration and improved the clinical outcomes. This method is considered to be a relatively safe and effective treatment modality.
authors.affiliation: Depatment of Orthopaedic Surgery, Chonbuk National University Hospital & Research Institute of Clinical Medicine, Chonbuk National University School of Medicine, Jeonju, Korea.
authors.forename: Kyung Jin
authors.initials: KJ
authors.lastname: Song
authors.forename: Gyu Hyung
authors.initials: GH
authors.lastname: Kim
authors.forename: Byeong Yeol
authors.initials: BY
authors.lastname: Choi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D001860:Bone Plates / Q000009:adverse effects; D001863:Bone Screws / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007659:Ketones; D008141:Lordosis / Q000473:pathology; D008297:Male; D011843:Radiculopathy / Q000601:surgery; D011859:Radiography; D012720:Severity of Illness Index; D013118:Spinal Cord Diseases / Q000601:surgery; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D007659:Ketones